Healthcare Provider Details

I. General information

NPI: 1811059066
Provider Name (Legal Business Name): ELIZABETH A. KAISER RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 5TH ST
SANTA ROSA CA
95404-4428
US

IV. Provider business mailing address

625 5TH ST
SANTA ROSA CA
95404-4428
US

V. Phone/Fax

Practice location:
  • Phone: 707-565-4446
  • Fax:
Mailing address:
  • Phone: 707-565-4446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number665668
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number69592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: